Implementation status of the free newborn care program in Gandaki Province, Nepal.

Background: In line with the Nepal Every Newborn Action Plan, the Government of Nepal has implemented the Free Newborn Care Program (FNCP) since 2016. As per the program guidelines, Specialized Newborn Care Units (SNCU) are established in hospitals to care for sick newborns. This study aims to explore the implementation status of free newborn healthcare services in Gandaki Province.

Methodology: An exploratory descriptive qualitative design was adopted for the study, which was conducted from August to October 2022. The study involved 114 exit client interviews and 12 key informant interviews, 6 focused group discussions, and onsite observations of 12 health institutions in the 11 districts of Gandaki Province. The researchers used thematic analysis techniques to analyze and report the findings.

Results: All institutions with SNCUs have achieved the level of infrastructure outlined by the FNCP guidelines. A shortage of doctors and nurses, and high staff turnover were prevalent. Insufficient training for nurses and short retention of trained personnel have been identified as major challenges. Commitment to following care standards can strengthen existing quality assurance efforts. There are perceived inadequacies in packages regarding medicines, supplies, and incentives. Even though the out-of-pocket expense was Nepalese Rupees 3000 (Inter Quartile Range (IQR) 1975-6125), comprising 60% (IQR 50-75) of total newborn care, 93% of the clients were satisfied.

Conclusion: Despite noticeable areas for improvement, the Free Newborn Care Program has successfully provided health services to families requiring critical newborn care. Key recommendations to improve its implementation include establishing sustainable onsite mentoring programs, policy measures for linking free newborn care with health insurance schemes, and monitoring mechanisms to ensure protocol adherence and quality assurance.